PCOS and Weight Gain: How Are They Connected?

From insulin resistance to impaired appetite-regulating hormones, there are many ways PCOS can cause weight gain. Here's how you can tackle PCOS-related obesity.
Medical Reviewer: Florencia Halperin, MD
Published on: May 5, 2022
Updated on: November 2, 2023

Learn more about how FORM pairs patients with a doctor and dietitian to achieve their weight loss goals.

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Polycystic Ovary Syndrome (PCOS) is a common condition, affecting about 1 in 10 women of reproductive age in the United States. The cause of PCOS is complex and symptoms can be vague, so this number may be even higher as the condition is often undiagnosed. It is frequently not until a woman is trying to conceive that she learns she has PCOS, as it is a common cause of infertility. Not only that, but it is also associated with excess body weight and increases the risk of many chronic conditions including diabetes, high blood pressure, and high cholesterol. But what’s the relationship between PCOS and weight gain? It isn’t entirely clear, but here’s what we know. 

What’s the Correlation Between Polycystic Ovary Syndrome and Weight Gain?

Excess body weight is commonly associated with PCOS. The prevalence of women with PCOS in the United States who also have excess body weight may be as high as 80%. It is somewhat unclear which came first though – does weight gain cause PCOS or does having PCOS cause weight gain? We have much more to learn.  

PCOS is understood to be a complex hormonal, metabolic and reproductive disorder, with genetic and environmental influences. It is characterized by abnormal hormone levels and dysfunction of the ovaries, which can cause symptoms such as irregular menstrual periods, excess body hair, acne, infertility, anxiety and depression and weight gain. A woman who may have biological tendencies towards PCOS may not have any symptoms at one weight, but develop symptoms when she gains weight. Likewise, many symptoms of PCOS resolve with weight loss, making weight loss a primary treatment strategy for women with PCOS if they have excess body weight. With that said, some of the following challenges have to be considered: 

  • Insulin Resistance

Insulin is a hormone involved in blood sugar regulation. When a person is insulin resistant, it means that their tissues don’t respond as well to insulin to take up blood sugar. This leads to increased blood sugar levels and the production of more insulin or a state called hyperinsulinemia. Hyperinsulinemia can make weight loss more challenging because insulin tells our body to store fat and it makes us feel hungrier, thereby increasing food intake. While often associated with excess body weight, even lean women with PCOS have evidence of insulin resistance

  • Impaired Appetite-Regulating Hormones

Ghrelin, also known as our “hunger hormone”, stimulates appetite and encourages us to 

eat. It appears that women with PCOS have lower fasting and post-meal levels of ghrelin, which may affect their satisfaction with a meal and desire to stop eating.

  • Anxiety and Depression

Studies have shown that women with PCOS are more likely to have moderate to severe depression and anxiety. Negative emotions such as those experienced with depression and anxiety have the potential to cause changes in food intake that can lead to weight gain. Additionally, antidepressants often have weight gain as a side effect, so treatment for both anxiety and depression associated with PCOS could affect weight loss efforts. 

  • Fatigue

Healthy habits such as meal preparation and regular physical activity require adequate energy and studies show that women with PCOS are more likely to experience fatigue than women without PCOS. This appears to be related to an increase in the prevalence of sleep disorders including Obstructive Sleep Apnea (OSA), which is another risk factor for weight gain. 

  • Treatment Side Effects

Oral contraceptives are a mainstay of treatment for PCOS. Some women experience weight gain as a side effect of oral contraceptives. Additionally, some medications used to treat the infertility associated with PCOS, such as letrozole, have weight gain potential. 

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Health Risks Associated with PCOS and Weight Gain

There are a number of chronic conditions associated with PCOS and weight gain, many of which can be improved or prevented with weight management. 

  • Type 2 diabetes
  • High cholesterol
  • High blood pressure
  • Metabolic syndrome
  • Fatty liver disease
  • Obstructive sleep apnea (OSA)
  • Anxiety and Depression
  • Infertility
  • Endometrial cancer 

How to Lose Weight with PCOS

Weight management is a first line treatment of PCOS and while there are some challenges specific to women who have PCOS, many studies have shown that it is possible. Lifestyle changes like adopting a healthy reduced-calorie diet, increasing physical activity, and implementing behavior changes that make these healthy habits sustainable are key to any weight loss journey. For women with PCOS, there may be some additional benefit from adopting a lower carbohydrate diet, however, the research is mixed and suggests that generally reducing caloric intake is what is needed. Additionally, adopting healthful eating habits that are sustainable is important. 

Physical activity undoubtedly plays a role as well. Not only is physical activity important for weight loss and weight loss maintenance, it also helps to reduce the insulin resistance associated with PCOS and the risk for conditions like high blood pressure, high cholesterol, and diabetes. If you hate the gym, that’s ok! Start by taking a walk with a friend or doing a free yoga video online. Any movement is better than no movement at all. 

If you’re adopting healthier habits, but still having difficulty losing weight or keeping it off, you may be a candidate for prescription weight loss medications that could help. These medications help to reduce appetite and cravings, making it easier for you to stick to a reduced-calorie diet. There are also options that can help to regulate your blood sugar levels and improve the insulin resistance associated with PCOS. Talk to your healthcare provider or consider a telehealth option like FORM, where the providers are experts in weight management and can help you find a solution that works for you. 

For women living with PCOS, weight loss can often feel like an impossible task, but working with an expert team can provide you the support and guidance to help you reach your goals. FORM will pair you with a team of medical experts who use research-backed tools to help you lose weight and improve your overall health. Our insurance-covered medical weight loss program gives you the tools to help you lose weight while building new habits to keep it off. Our Board Certified Doctors and Registered Dietitians will create a personalized weight loss plan that includes nutrition, physical activity, mindset shifts and FDA-approved medication, if appropriate. The program is delivered entirely through the FORM app which allows patients unlimited, frequent communication with their care team via video visits and messaging, weight and food tracking, and access to educational content. 

If you are looking for an online weight loss doctor who can help you lose weight caused by PCOS, FORM’s medical weight loss program may be right for you. Get started today by taking our quiz to see if medical weight loss is right for you.

Questions about medical weight loss? Schedule a free call with an enrollment specialist to learn more.

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